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Exhibit D – Sample ContractRFQ 1436-522

PERSONAL SERVICE CONTRACT

Specialized Psychological

Consultative Services

DSHS Contract Number:Click here to enter text.Resulting From Procurement Number:

This Contract is between the state of Washington Department of Social

and Health Services (DSHS) and the Contractor identified below, and is

governed by chapter 39.2

6 RCW.

Program Contract Number:Click here to enter text.Contractor Contract Number:

CONTRACTOR NAMEClick here to enter text.

CONTRACTOR doing business as (DBA)Click here to enter text.

CONTRACTOR ADDRESSClick here to enter text.Click here to enter text., Click here to enter text. Click here to enter text.

WASHINGTON UNIFORM BUSINESS IDENTIFIER (UBI)Click here to enter text.

DSHS INDEX NUMBER

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CONTRACTOR CONTACTClick here to enter text.

CONTRACTOR TELEPHONEClick here to enter text.

CONTRACTOR FAXClick here to enter text.

CONTRACTOR E-MAIL ADDRESSClick here to enter text.

DSHS ADMINISTRATIONClick here to enter text.

DSHS DIVISIONClick here to enter text.

DSHS CONTRACT CODEClick here to enter text.

DSHS CONTACT NAME AND TITLEClick here to enter text.Click here to enter text.

DSHS CONTACT ADDRESSClick here to enter text.Click here to enter text., Click here to enter text. Click here to enter text.

DSHS CONTACT TELEPHONEClick here to enter text.

DSHS CONTACT FAXClick here to enter text.

DSHS CONTACT E-MAIL ADDRESSClick here to enter text.

IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT?Click here to enter text.

CFDA NUMBER(S)Click here to enter text.

CONTRACT START DATEClick here to enter text.

CONTRACT END DATEClick here to enter text.

CONTRACT MAXIMUM AMOUNTClick here to enter text.

EXHIBITS. The following Exhibits are attached and are incorporated into this Contract by reference: Exhibits (specify): No Exhibits.

The terms and conditions of this Contract are an integration and representation of the final, entire and exclusive understanding between the parties superseding and merging all previous agreements, writings, and communications, oral or otherwise, regarding the subject matter of this Contract. The parties signing below represent that they have read and understand this Contract, and have the authority to execute this Contract. This Contract shall be binding on DSHS only upon signature by DSHS.CONTRACTOR SIGNATURE

SAMPLE DO NOT SIGNClick here to enter text.

PRINTED NAME AND TITLE

SAMPLE DO NOT SIGN

DATE SIGNED

SAMPLEDSHS SIGNATURE PRINTED NAME AND TITLE DATE SIGNED

DSHS Central Contract Services3722PP DDDS Specialized Psychological Consultative Services (9-10-15) RFQ 1436-522 Exhibit D – Sample Contract

Exhibit D – Sample ContractRFQ 1436-522

SAMPLE DO NOT SIGNClick here to enter text.

Lisa Stout, Fiscal ManagerDepartment of Social and Health Services(DSHS)Economic Services Administration (ESA)Division of Disability Determination Services (DDDS)

SAMPLE


DSHS General Terms and Conditions

1. Definitions. The words and phrases listed below, as used in this Contract, shall each have the following definitions:

a. “Central Contract Services” means the DSHS central headquarters contracting office, or successor section or office.

b. “Confidential Information” or “Data” means information that is exempt from disclosure to the public or other unauthorized persons under RCW 42.56 or other federal or state laws. Confidential Information includes, but is not limited to, Personal Information.

c. “Contract” or “Agreement” means the entire written agreement between DSHS and the Contractor, including any Exhibits, documents, or materials incorporated by reference. The parties may execute this contract in multiple counterparts, each of which is deemed an original and all of which constitute only one agreement. E-mail or Facsimile transmission of a signed copy of this contract shall be the same as delivery of an original.

d. “Contracts Administrator” means the manager, or successor, of Central Contract Services or successor section or office.

e. “Contractor” means the individual or entity performing services pursuant to this Contract and includes the Contractor’s owners, members, officers, directors, partners, employees, and/or agents, unless otherwise stated in this Contract. For purposes of any permitted Subcontract, “Contractor” includes any Subcontractor and its owners, members, officers, directors, partners, employees, and/or agents.

f. “Debarment” means an action taken by a Federal agency or official to exclude a person or business entity from participating in transactions involving certain federal funds.

g. “DSHS” or the “Department” means the state of Washington Department of Social and Health Services and its employees and authorized agents.

h. “Encrypt” means to encode Confidential Information into a format that can only be read by those possessing a “key”; a password, digital certificate or other mechanism available only to authorized users. Encryption must use a key length of at least 128 bits.

i. “Personal Information” means information identifiable to any person, including, but not limited to, information that relates to a person’s name, health, finances, education, business, use or receipt of governmental services or other activities, addresses, telephone numbers, Social Security Numbers, driver license numbers, other identifying numbers, and any financial identifiers.

j. “Physically Secure” means that access is restricted through physical means to authorized individuals only.

k. “Program Agreement” means an agreement between the Contractor and DSHS containing special terms and conditions, including a statement of work to be performed by the Contractor and payment to be made by DSHS.

l. “RCW” means the Revised Code of Washington. All references in this Contract to RCW chapters or sections shall include any successor, amended, or replacement statute. Pertinent RCW chapters can be accessed at http://apps.leg.wa.gov/rcw/.



m. “Regulation” means any federal, state, or local regulation, rule, or ordinance.

n. “Secured Area” means an area to which only authorized representatives of the entity possessing the Confidential Information have access. Secured Areas may include buildings, rooms or locked storage containers (such as a filing cabinet) within a room, as long as access to the Confidential Information is not available to unauthorized personnel.

o. “Subcontract” means any separate agreement or contract between the Contractor and an individual or entity (“Subcontractor”) to perform all or a portion of the duties and obligations that the Contractor is obligated to perform pursuant to this Contract.

p. “Tracking” means a record keeping system that identifies when the sender begins delivery of Confidential Information to the authorized and intended recipient, and when the sender receives confirmation of delivery from the authorized and intended recipient of Confidential Information.

q. “Trusted Systems” include only the following methods of physical delivery: (1) hand-delivery by a person authorized to have access to the Confidential Information with written acknowledgement of receipt; (2) United States Postal Service (“USPS”) first class mail, or USPS delivery services that include Tracking, such as Certified Mail, Express Mail or Registered Mail; (3) commercial delivery services (e.g. FedEx, UPS, DHL) which offer tracking and receipt confirmation; and (4) the Washington State Campus mail system. For electronic transmission, the Washington State Governmental Network (SGN) is a Trusted System for communications within that Network.

r. “WAC” means the Washington Administrative Code. All references in this Contract to WAC chapters or sections shall include any successor, amended, or replacement regulation. Pertinent WAC chapters or sections can be accessed at http://apps.leg.wa.gov/wac/.

2. Amendment. This Contract may only be modified by a written amendment signed by both parties. Only personnel authorized to bind each of the parties may sign an amendment.

3. Assignment. The Contractor shall not assign this Contract or any Program Agreement to a third party without the prior written consent of DSHS.

4. Billing Limitations.

a. DSHS shall pay the Contractor only for authorized services provided in accordance with this Contract.

b. DSHS shall not pay any claims for payment for services submitted more than twelve (12) months after the calendar month in which the services were performed.

c. The Contractor shall not bill and DSHS shall not pay for services performed under this Contract, if the Contractor has charged or will charge another agency of the state of Washington or any other party for the same services.

5. Compliance with Applicable Law. At all times during the term of this Contract, the Contractor shall comply with all applicable federal, state, and local laws and regulations, including but not limited to, nondiscrimination laws and regulations.

6. Confidentiality.



a. The Contractor shall not use, publish, transfer, sell or otherwise disclose any Confidential Information gained by reason of this Contract for any purpose that is not directly connected with Contractor’s performance of the services contemplated hereunder, except:

(1) as provided by law; or,

(2) in the case of Personal Information, with the prior written consent of the person or personal representative of the person who is the subject of the Personal Information.

b. The Contractor shall protect and maintain all Confidential Information gained by reason of this Contract against unauthorized use, access, disclosure, modification or loss. This duty requires the Contractor to employ reasonable security measures, which include restricting access to the Confidential Information by:

(1) Allowing access only to staff that have an authorized business requirement to view the Confidential Information.

(2) Physically Securing any computers, documents, or other media containing the Confidential Information.

(3) Ensure the security of Confidential Information transmitted via fax (facsimile) by:

(a) Verifying the recipient phone number to prevent accidental transmittal of Confidential Information to unauthorized persons.

(b) Communicating with the intended recipient before transmission to ensure that the fax will be received only by an authorized person.

(c) Verifying after transmittal that the fax was received by the intended recipient.

(4) When transporting six (6) or more records containing Confidential Information, outside a Secured Area, do one or more of the following as appropriate:

(a) Use a Trusted System.

(b) Encrypt the Confidential Information, including:

i. Encrypting email and/or email attachments which contain the Confidential Information.ii. Encrypting Confidential Information when it is stored on portable devices or media,

including but not limited to laptop computers and flash memory devices.

Note: If the DSHS Data Security Requirements Exhibit is attached to this contract, this item, 6.b.(4), is superseded by the language contained in the Exhibit.

(5) Send paper documents containing Confidential Information via a Trusted System.

(6) Following the requirements of the DSHS Data Security Requirements Exhibit, if attached to this contract.

c. Upon request by DSHS, at the end of the Contract term, or when no longer needed, Confidential Information shall be returned to DSHS or Contractor shall certify in writing that they employed a DSHS approved method to destroy the information. Contractor may obtain information regarding



approved destruction methods from the DSHS contact identified on the cover page of this Contract.

d. Paper documents with Confidential Information may be recycled through a contracted firm, provided the contract with the recycler specifies that the confidentiality of information will be protected, and the information destroyed through the recycling process. Paper documents containing Confidential Information requiring special handling (e.g. protected health information) must be destroyed on-site through shredding, pulping, or incineration.

e. Notification of Compromise or Potential Compromise. The compromise or potential compromise of Confidential Information must be reported to the DSHS Contact designated on the contract within one (1) business day of discovery. Contractor must also take actions to mitigate the risk of loss and comply with any notification or other requirements imposed by law or DSHS.

7. Debarment Certification. The Contractor, by signature to this Contract, certifies that the Contractor is not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal department or agency from participating in transactions (Debarred). The Contractor also agrees to include the above requirement in any and all Subcontracts into which it enters. The Contractor shall immediately notify DSHS if, during the term of this Contract, Contractor becomes Debarred. DSHS may immediately terminate this Contract by providing Contractor written notice if Contractor becomes Debarred during the term hereof.

8. Governing Law and Venue. This Contract shall be construed and interpreted in accordance with the laws of the state of Washington and the venue of any action brought hereunder shall be in Superior Court for Thurston County.

9. Independent Contractor. The parties intend that an independent contractor relationship will be created by this Contract. The Contractor and his or her employees or agents performing under this Contract are not employees or agents of the Department. The Contractor, his or her employees, or agents performing under this Contract will not hold himself/herself out as, nor claim to be, an officer or employee of the Department by reason hereof, nor will the Contractor, his or her employees, or agent make any claim of right, privilege or benefit that would accrue to such officer or employee.

10. Inspection. The Contractor shall, at no cost, provide DSHS and the Office of the State Auditor with reasonable access to Contractor’s place of business, Contractor’s records, and DSHS client records, wherever located. These inspection rights are intended to allow DSHS and the Office of the State Auditor to monitor, audit, and evaluate the Contractor’s performance and compliance with applicable laws, regulations, and these Contract terms. These inspection rights shall survive for six (6) years following this Contract’s termination or expiration.

11. Maintenance of Records. The Contractor shall maintain records relating to this Contract and the performance of the services described herein. The records include, but are not limited to, accounting procedures and practices, which sufficiently and properly reflect all direct and indirect costs of any nature expended in the performance of this Contract. All records and other material relevant to this Contract shall be retained for six (6) years after expiration or termination of this Contract.

Without agreeing that litigation or claims are legally authorized, if any litigation, claim, or audit is started before the expiration of the six (6) year period, the records shall be retained until all litigation, claims, or audit findings involving the records have been resolved.

12. Order of Precedence. In the event of any inconsistency or conflict between the General Terms and Conditions and the Special Terms and Conditions of this Contract or any Program Agreement, the



inconsistency or conflict shall be resolved by giving precedence to these General Terms and Conditions. Terms or conditions that are more restrictive, specific, or particular than those contained in the General Terms and Conditions shall not be construed as being inconsistent or in conflict.

13. Severability. If any term or condition of this Contract is held invalid by any court, the remainder of the Contract remains valid and in full force and effect.

14. Survivability. The terms and conditions contained in this Contract or any Program Agreement which, by their sense and context, are intended to survive the expiration or termination of the particular agreement shall survive. Surviving terms include, but are not limited to: Billing Limitations; Confidentiality, Disputes; Indemnification and Hold Harmless, Inspection, Maintenance of Records, Notice of Overpayment, Ownership of Material, Termination for Default, Termination Procedure, and Treatment of Property.

15. Contract Renegotiation, Suspension, or Termination Due to Change in Funding.

If the funds DSHS relied upon to establish this Contract or Program Agreement are withdrawn, reduced or limited, or if additional or modified conditions are placed on such funding, after the effective date of this contract but prior to the normal completion of this Contract or Program Agreement:

a. At DSHS’s discretion, the Contract or Program Agreement may be renegotiated under the revised funding conditions.

b. DSHS’s discretion, DSHS may give notice to Contractor to suspend performance when DSHS determines that there is reasonable likelihood that the funding insufficiency may be resolved in a timeframe that would allow Contractor’s performance to be resumed prior to the normal completion date of this contract.

(1) During the period of suspension of performance, each party will inform the other of any conditions that may reasonably affect the potential for resumption of performance.

(2) When DSHS determines that the funding insufficiency is resolved, it will give Contractor written notice to resume performance. Upon the receipt of this notice, Contractor will provide written notice to DSHS informing DSHS whether it can resume performance and, if so, the date of resumption. For purposes of this subsubsection, “written notice” may include email.

(3) If the Contractor’s proposed resumption date is not acceptable to DSHS and an acceptable date cannot be negotiated, DSHS may terminate the contract by giving written notice to Contractor. The parties agree that the Contract will be terminated retroactive to the date of the notice of suspension. DSHS shall be liable only for payment in accordance with the terms of this Contract for services rendered prior to the retroactive date of termination.

c. DSHS may immediately terminate this Contract by providing written notice to the Contractor. The termination shall be effective on the date specified in the termination notice. DSHS shall be liable only for payment in accordance with the terms of this Contract for services rendered prior to the effective date of termination. No penalty shall accrue to DSHS in the event the termination option in this section is exercised.

16. Waiver. Waiver of any breach or default on any occasion shall not be deemed to be a waiver of any subsequent breach or default. Any waiver shall not be construed to be a modification of the terms and conditions of this Contract. Only the DSHS Contracts Administrator or designee has the authority to



waive any term or condition of this Contract on behalf of DSHS.

Additional General Terms and Conditions – Personal Service Contracts:

17. Advance Payment. DSHS shall not make any payments in advance or anticipation of the delivery of services to be provided pursuant to this Contract.

18. Construction. The language in this Contract shall be interpreted as to its fair meaning and not strictly for or against any party. Any rule of construction to the effect that ambiguities are to be resolved against the drafting party shall not apply in interpreting this Contract.

19. Indemnification and Hold Harmless.

a. The Contractor shall be responsible for and shall indemnify, defend, and hold DSHS harmless from any and all claims, costs, charges, penalties, demands, losses, liabilities, damages, judgments, or fines, of whatsoever kind of nature, arising out of or relating to a) the Contractor’s or any Subcontractor’s performance or failure to perform this Contract, or b) the acts or omissions of the Contractor or any Subcontractor.

b. The Contractor’s duty to indemnify, defend, and hold DSHS harmless from any and all claims, costs, charges, penalties, demands, losses, liabilities, damages, judgments, or fines shall include DSHS’ personnel-related costs, reasonable attorney’s fees, court costs, and all related expenses.

c. The Contractor waives its immunity under Title 51 RCW to the extent it is required to indemnify, defend, and hold harmless the State and its agencies, officials, agents, or employees.

d. Nothing in this term shall be construed as a modification or limitation on the Contractor’s obligation to procure insurance in accordance with this Contract or the scope of said insurance.

20. Industrial Insurance Coverage. The Contractor shall comply with the provisions of Title 51 RCW, Industrial Insurance. If the Contractor fails to provide industrial insurance coverage or fails to pay premiums or penalties on behalf of its employees, as may be required by law, Agency may collect from the Contractor the full amount payable to the Industrial Insurance accident fund. The Agency may deduct the amount owed by the Contractor to the accident fund from the amount payable to the Contractor by the Agency under this contract, and transmit the deducted amount to the Department of Labor and Industries, (L&I) Division of Insurance Services. This provision does not waive any of L&I’s rights to collect from the Contractor.

21. Notice of Overpayment. If the Contractor receives a vendor overpayment notice or a letter communicating the existence of an overpayment from DSHS, the Contractor may protest the overpayment determination by requesting an adjudicative proceeding. The Contractor’s request for an adjudicative proceeding must:

a. Be received by the Office of Financial Recovery (OFR) at Post Office Box 9501, Olympia, Washington 98507-9501, within twenty-eight (28) calendar days of service of the notice;

b. Be sent by certified mail (return receipt) or other manner that proves OFR received the request;

c. Include a statement as to why the Contractor thinks the notice is incorrect; and



d. Include a copy of the overpayment notice.

Timely and complete requests will be scheduled for a formal hearing by the Office of Administrative Hearings. The Contractor may be offered a pre-hearing or alternative dispute resolution conference in an attempt to resolve the overpayment dispute prior to the hearing.

Failure to provide OFR with a written request for a hearing within twenty-eight (28) days of service of a vendor overpayment notice or other overpayment letter will result in an overpayment debt against the Contractor. DSHS may charge the Contractor interest and any costs associated with the collection of this overpayment. DSHS may collect an overpayment debt through lien, foreclosure, seizure and sale of the Contractor’s real or personal property; order to withhold and deliver; or any other collection action available to DSHS to satisfy the overpayment debt.

22. DES Filing Requirement. Under RCW 39.26, sole source contracts and amendments must be filed with the State of Washington Department of Enterprise Services (DES). If this Contract is one that must be filed, it shall not be effective nor shall work commence or payment be made until it has been approved by DES. In the event DES fails to approve the Contract or any amendment hereto, the Contract or amendment shall be null and void.

23. Subcontracting. Except as otherwise provided in this Contract, the Contractor shall not Subcontract any of the contracted services without the prior written approval of DSHS. Contractor is responsible to ensure that all terms, conditions, assurances and certifications set forth in this Contract are included in any and all Subcontracts. Any failure of Contractor or its Subcontractors to perform the obligations of this Contract shall not discharge the Contractor from its obligations hereunder or diminish DSHS’ rights or remedies available under this Contract.

24. Termination for Convenience. DSHS may terminate this Contract in whole or in part when it is in the best interest of DSHS by giving the Contractor at least thirty (30) calendar days’ written notice.

25. Termination for Default. The Contracts Administrator may immediately terminate this Contract for default, in whole or in part, by written notice to the Contractor if DSHS has a reasonable basis to believe that the Contractor has:

a. Failed to meet or maintain any requirement for contracting with DSHS;

b. Failed to protect the health or safety of any DSHS client;

c. Failed to perform under, or otherwise breached, any term or condition of this Contract; and/or

d. Violated any applicable law or regulation.

e. If it is later determined that the Contractor was not in default, the termination shall be considered a termination for convenience.

26. Termination or Expiration Procedure. The following terms and conditions apply upon Contract termination or expiration:

a. The Contractor shall cease to perform any services required by this Contract as of the effective date of termination or expiration.

b. If the Contract is terminated, the Contractor shall comply with all instructions contained in the



termination notice.

c. The Contractor shall immediately deliver to the DSHS contact named on page one of this Contract, or to his or her successor, all DSHS property in the Contractor’s possession. The Contractor grants DSHS the right to enter upon the Contractor’s premises for the sole purpose of recovering any DSHS property that the Contractor fails to return within ten (10) calendar days of the effective date of termination or expiration of this Contract. Upon failure to return DSHS property within ten (10) calendar days, the Contractor shall be charged with all reasonable costs of recovery, including transportation.

d. DSHS shall be liable only for payment required under the terms of this Contract for service rendered up to the effective date of termination or expiration.

e. DSHS may withhold a sum from the final payment to the Contractor that DSHS determines necessary to protect DSHS against loss or additional liability.

f. The rights and remedies provided to DSHS in this Section are in addition to any other rights and remedies provided at law, in equity, and/or under this Contract, including consequential and incidental damages.

27. Treatment of Property. All property purchased or furnished by DSHS for use by the Contractor during this Contract term shall remain with DSHS. Title to all property purchased or furnished by the Contractor for which the Contractor is entitled to reimbursement by DSHS under this Contract shall pass to and vest in DSHS. The Contractor shall protect, maintain, and insure all DSHS property in its possession against loss or damage and shall return DSHS property to DSHS upon Contract termination or expiration.

28. Taxes.

a. Where required by statute or regulation, Contractor shall pay for and maintain in current status all taxes that are necessary for Contract performance. DSHS will pay sales or use taxes, if any, imposed on the services and materials acquired hereunder. Contractor must pay all other taxes including without limitation Washington Business and Occupation Tax, other taxes based on Contractor’s income or gross receipts, or personal property taxes levied or assessed on Contractor’s personal property. DSHS, as an agency of Washington State government, is exempt from property tax.

b. Contractor shall complete registration with the Washington State Department of Revenue and be responsible for payment of all taxes due on payments made under this Contract in accordance with the requirements of Title 82 RCW and Title 458 WAC. Out-of-state Contractors must contact the Department of Revenue to determine whether they meet criteria to register and establish an account with the Department of Revenue. Refer to WAC 458-20-93 and call the Department of Revenue at 800-647-7706 for additional information. When out-of-state Contractors are not required to collect and remit sales tax, DSHS shall be responsible for paying use tax, if applicable, directly to the Department of Revenue.

c. All payments accrued on account of payroll taxes, unemployment contributions, any other taxes, insurance, or other expenses for Contractor or Contractor’s staff shall be Contractor’s sole responsibility.


http://apps.leg.wa.gov/wac/default.aspx?cite=458-20-193

http://apps.leg.wa.gov/wac/default.aspx?cite=458

http://apps.leg.wa.gov/rcw/default.aspx?Cite=82

Special Terms and Conditions

1. Definitions. The words and phrases listed below, as used in this Contract, shall each have the following definitions:

a. “ESA” means the Economic Services Administration in the Department of Social and Health Services.

b. “DDDS” means the Division of Disability Determination Services, a Division of the Economic Services Administration.

c. “SSA” means the Social Security Administration, a Federal Agency.

d. “Impairments” means a client’s physical or mental impairments as defined in Program Operation Manual System (POMS) DI 24501.020, as now written or hereafter amended.

e. “SSA Enterprise Network” means SSA proprietary software systems.

f. “PII” means Personally Identifiable Information and is any information about an individual maintained by an agency, including (1) any information that can be used to distinguish or trace an individual‘s identity, such as name, social security number, date and place of birth, mother‘s maiden name, or biometric records; and (2) any other information that is linked or linkable to an individual, such as medical, educational, financial, and employment information.

g. “POMS” means Program Operations Manual System, regulations of The Social Security Act.

h. “Timekeeper" means official time tracking system.

2. Purpose. The purpose of this Contract is to provide medical and psychological consultative services to DSHS/DDDS adjudicative staff and others who make disability determinations on behalf of the Social Security Administration.

3. Previous Contract Superseded. In the event any previous contract between Contractor and ESA/DDDS for these services should be in effect upon execution of this Contract, this Contract shall terminate and supersede previous Contract N° .

4. Statement of Work. The Contractor shall provide the services and staff, and otherwise do all things necessary for or incidental to the performance of work, as set forth below. The Contractor shall:

a. Be a psychologist or physician who meets the qualifications for a needed specialty and be fully licensed by the State of Washington at the time the work is performed.

b. Provide the following services:

(1) Psychological consultation and expertise needed to document the specific impairments and to determine severity as required by the Social Security Disability regulations;

(2) Verify that decisions are supported by medical or psychological data, or if not, provide a statement specifying the medical or psychological information needed and authorize such testing as necessary; Review and sign properly prepared cases consistent with WA DDDS Business Process, POMS, and SSA directives;

(3) Written opinions of a claimant’s functional limitations or remaining functional capacity;



(4) Consultation with the claimant’s attending physician or consultative examiner to clarify medical or psychological documentation or to resolve medical or psychological severity determination problems;

(5) Following completion of the contractor’s training as determined by DDDS management, the Contractor is expected to complete a minimum of one (1) case per hour for case review, conclusions and signature, as documented monthly by the medical consultant performance report and timekeeper for base pay rate. Contractor will qualify for incentive pay rate for completing cases per hour for case review, conclusions and signature, as documented monthly by the medical consultant performance report and timekeeper. Time spent on any SSA/DDS business, other than case review, will not be considered in the formula for determining incentive pay;

(6) Acceptable Timekeeper activities codes:

01 – Case Review

02 – Consult/Questions

03 – Training: giving or receiving training. Includes MCs, Adjudicator, IT, or special projects.

04 – Email

07 – Meetings

08 – Out of State Case Review (includes Oregon or any other state we may assist)

(7) A thorough review of cases and assessment of the sufficiency of evidence for a decision per SSA regulations under the Social Security Act and as evidenced by the medical consultant report;

(8) Maintenance of a level of quality and timeliness that satisfies all SSA/DDDS requirements and standards in all cases;

(9) Medical/psychological training to adjudicative staff and other medical consultants as situations may require;

(10) Attendance at training sessions as requested;

(11) Consultation and instruction on medical issues through face-to-face, telephone, or Medical Advice Summary screen (email should not be utilized for case discussion or case specific questions). Forms should not be completed or re-written by MCs, but should be returned to the adjudicator with advice for correction or completion;

(12) Consistent with SSA POMS, and current psychological practices, adjudicate material differences in second opinions to assist with the most appropriate disability determination;

(13) Assist in training new Psychological Medical Consultants, as needed; and

(14) Serve as a consultant to the Division Director to ensure psychological reviews are conducted consistent with SSA POMS and current psychological practices.



c. Attend program orientation at contract initiation and as necessary.

d. Attend mandatory quarterly meetings at the DSHS/DDDS office on the time and day as designated by the division, in order for the Contractor to remain current with policy changes implemented by The Social Security Administration to fulfill contractual services. The Contractor shall:

(1) Be paid, at the contracted amount per hour, for meetings attended. The Contractor shall bill service time equivalent to the length of the attended meeting.

(2) Provide written notice and receive approval from the Office Chief or designee if unavoidable conflict necessitates an absence from a meeting.

e. Use DSHS/DDDS assets and resources made available only to provide services under this Contract;

f. Schedule some consultation periods within office hours Monday – Friday 6am – 6pm;

g. Protect the security and integrity of the SSA Enterprise Network laptop computers and/or computer peripherals as may be made available by SSA. Equipment made available for Contractor use shall be used for DSHS/DDDS work-related activities only. Off-site equipment shall be secured to ensure that no one except the contractor has access to it. Equipment made available to an independent contractor shall be returned to DSHS/DDDS upon termination of contract, or when requested by DSHS/DDDS;

h. Provide DSHS/DDDS access to inspect the Contractor’s workspace to insure that confidentiality and security of claims folders and equipment is maintained;

i. Follow all SSA rules pertaining to security of files, systems and confidential information. SSA security policy is available for review from DSHS/DDDS and is incorporated herein by reference; Entering PII in an internet search engine or social media network may compromise the confidentiality of PII and is against SSA policy. The responsibility to protect PII within the contractor’s control applies at all times, regardless of whether the employee is at an official duty station, another official work location, an alternate duty station, or off duty. This applies whether the contractor is using a computer or personal device (for example, Blackberry or Smartphone);

j. Comply with all applicable worker’s compensation, occupational disease, and occupational health and safety laws and regulations. The State of Washington and DSHS/DDDS shall not be held responsible for claims filed by the Contractor or its employees under such laws and regulations;

k. Produce SSA program documents using the appropriate electronic or paper process as mandated by SSA; and

l. Provide DSHS/DDDS two weeks written notice of scheduled absences of three weeks or longer, whenever possible.

The Contractor and DSHS/DDDS shall communicate with each other in a manner that is professional and respectful and promotes a positive working relationship.

5. Criminal History Background Checks. Washington State Criminal History background checks may be required for all employees, contractors, subcontractors, and/or volunteers who may have access to SSA data, SSA and/or DSHS – DDDS policy. DDDS reserves the right to initiate such background checks at management discretion.



6. Monitoring

DSHS/DDDS shall review the Contractor’s work on a monthly basis and will set forth procedures for taking corrective action if a contractor falls below the minimum standards. Any finding by DSHS/DDDS that the Contractor’s work is unsatisfactory may result in the termination or non-renewal of this Contract.

Contractor will attend a mandatory pre-contract orientation, conducted by DDDS, prior to signing and receiving a contract.

7. Consideration

Total consideration payable to Contractor for satisfactory performance of direct DDDS work under this Contract, shall be paid in accordance with the following schedule:

a. Contractor produces up to cases per hour equals per hour for total monthly hours.

b. Contractor produces a minimum of cases per hour equals per hour for total monthly hours.

c. Personal or non-SSA/DDS business time will not be included in timekeeper hours and is not billable under this contract.

d. DSHS may change the hourly rate or total available hours, based on federal direction, budget constraints or management decision and shall provide notice to the Contractor in writing.

e. In the event there are no cases for review, the contractor will be required to log out of timekeeper and may be required to adjust scheduled hours.

f. In the event of termination of this contract, final payment will be held until signed off by the department.

8. Billing and Payment

a. Invoice System. The Contractor shall bill DSHS/DDDS on a monthly basis for hours of service delivered. The Contractor shall complete and submit to DDDS the Contractor Monthly Time Report form provided by DSHS/DDDS. The Contractor shall sign the form and obtain the signature of the program manager or designee.

b. Travel. Travel expenses, other than those identified here, will not be reimbursed with the exception of travel expenses incurred when the Contractor is requested to travel on behalf of DSHS/DDDS. Travel arrangements will be made by DSHS/DDDS or if made by the Contractor, must be approved by DSHS/DDDS prior to travel in order to be reimbursed in accordance with the rules and at the rates as published by the Office of Financial Management, State of Washington.

c. Payment. DSHS/DDDS shall mail the Contractor’s payment for services to the mailing address specified on page one (1) of this Contract or deliver payment to the Contractor by direct deposit as designated by the Contractor prior to payment.

d. Overpayment. If DSHS/DDDS pays the Contractor for services authorized but not provided by the Contractor in accordance with this Contract’s “Statement of Work,” the amount paid shall be considered to be an overpayment, and must be returned to the Department.



9. Disputes

a. Requesting dispute resolution:

The request for contract dispute resolution by either party shall:

(1) Be submitted to ESA in writing and include the Contractor’s name, address and the DSHS contract number;

(2) Be sent by certified mail or other method providing a signed receipt to the sender to prove delivery to and receipt by ESA, to the following address:

DSHS/ESA/Operations Support DivisionAttn. Contracts UnitPO Box 45445Olympia, WA 98504-5445

(3) Be received by the Operations Support Division no later than twenty-eight (28) calendar days after the contract expiration or termination.

(4) Identify in writing the spokesperson for the Contractor, if other than the Contractor’s signatory.

b. Content of the dispute request:

The party requesting a dispute resolution shall submit a statement that:

(1) Identifies the issue(s) in dispute

(2) Identifies the relative positions of the parties

(3) Requests resolution through the current ESA process

c. Action on the request:

(1) ESA shall notify the non-requesting party that the request has been made, notify both parties of the dispute resolution process to be followed, and manage the process to its conclusion.

(2) The Contractor shall provide pertinent information as requested by the person assigned to resolve the dispute.

d. Contractor and DSHS agree that, the existence of a dispute notwithstanding, they will continue without delay to carry out all their respective responsibilities under this Contract that are not affected by the dispute.

10. Notices

Whenever one party is required to give notice to the other party under this Contract, it shall be deemed given if mailed by United States Postal Service, registered or certified mail, return receipt requested, postage prepaid and addressed as follows:

a. In the case of notice to the Contractor, notice shall be sent to the Contractor’s point of contact identified on page one of this Contract;



b. In the case of notice to DSHS, notice shall be sent to:

Lisa Stout, Fiscal ManagerDivision of Disability Determination ServicesDepartment of Social and Health ServicesP. O. Box 79303Olympia, Washington 98507-9303

11. Said notice shall become effective on the date delivered as evidenced by the return receipt or the date returned to sender for non-delivery other than for insufficient postage. Either party may at any time change its address for notification purposes by mailing a notice in accordance with this Section, stating the change and setting forth the new address, which shall be effective on the tenth (10th) day following the effective date of such notice unless a later day is specified in the notice.



Exhibit A – Data Security Requirements

1. Definitions. The words and phrases listed below, as used in this Exhibit, shall each have the following definitions:

a. “Authorized User(s)” means an individual or individuals with an authorized business requirement to access DSHS Confidential Information.

b. “Hardened Password” means a string of at least eight characters containing at least one alphabetic character, at least one number and at least one special character such as an asterisk, ampersand or exclamation point.

c. “Unique User ID” means a string of characters that identifies a specific user and which, in conjunction with a password, passphrase or other mechanism, authenticates a user to an information system.

2. Data Transport. When transporting DSHS Confidential Information electronically, including via email, the Data will be protected by:

a. Transporting the Data within the (State Governmental Network) SGN or Contractor’s internal network, or;

b. Encrypting any Data that will be in transit outside the SGN or Contractor’s internal network. This includes transit over the public Internet.

3. Protection of Data. The Contractor agrees to store Data on one or more of the following media and protect the Data as described:

a. Hard disk drives. Data stored on local workstation hard disks. Access to the Data will be restricted to Authorized User(s) by requiring logon to the local workstation using a Unique User ID and Hardened Password or other authentication mechanisms which provide equal or greater security, such as biometrics or smart cards.

b. Network server disks. Data stored on hard disks mounted on network servers and made available through shared folders. Access to the Data will be restricted to Authorized Users through the use of access control lists which will grant access only after the Authorized User has authenticated to the network using a Unique User ID and Hardened Password or other authentication mechanisms which provide equal or greater security, such as biometrics or smart cards. Data on disks mounted to such servers must be located in an area which is accessible only to authorized personnel, with access controlled through use of a key, card key, combination lock, or comparable mechanism.

For DSHS Confidential Information stored on these disks, deleting unneeded Data is sufficient as long as the disks remain in a Secured Area and otherwise meet the requirements listed in the above paragraph. Destruction of the Data as outlined in Section 5. Data Disposition may be deferred until the disks are retired, replaced, or otherwise taken out of the Secured Area.



c. Optical discs (CDs or DVDs) in local workstation optical disc drives. Data provided by DSHS on optical discs which will be used in local workstation optical disc drives and which will not be transported out of a Secured Area. When not in use for the contracted purpose, such discs must be locked in a drawer, cabinet or other container to which only Authorized Users have the key, combination or mechanism required to access the contents of the container. Workstations which access DSHS Data on optical discs must be located in an area which is accessible only to authorized personnel, with access controlled through use of a key, card key, combination lock, or comparable mechanism.

d. Optical discs (CDs or DVDs) in drives or jukeboxes attached to servers. Data provided by DSHS on optical discs which will be attached to network servers and which will not be transported out of a Secured Area. Access to Data on these discs will be restricted to Authorized Users through the use of access control lists which will grant access only after the Authorized User has authenticated to the network using a Unique User ID and Hardened Password or other authentication mechanisms which provide equal or greater security, such as biometrics or smart cards. Data on discs attached to such servers must be located in an area which is accessible only to authorized personnel, with access controlled through use of a key, card key, combination lock, or comparable mechanism.

e. Paper documents. Any paper records must be protected by storing the records in a Secured Area which is only accessible to authorized personnel. When not in use, such records must be stored in a locked container, such as a file cabinet, locking drawer, or safe, to which only authorized persons have access.

f. Remote Access. Access to and use of the Data over the State Governmental Network (SGN) or Secure Access Washington (SAW) will be controlled by DSHS staff who will issue authentication credentials (e.g. a Unique User ID and Hardened Password) to Authorized Users on Contractor staff. Contractor will notify DSHS staff immediately whenever an Authorized User in possession of such credentials is terminated or otherwise leaves the employ of the Contractor, and whenever an Authorized User’s duties change such that the Authorized User no longer requires access to perform work for this Contract.

g. Data storage on portable devices or media.

(1) Except where otherwise specified herein, DSHS Data shall not be stored by the Contractor on portable devices or media unless specifically authorized within the terms and conditions of the Contract. If so authorized, the Data shall be given the following protections:

(a) Encrypt the Data with a key length of at least 128 bits

(b) Control access to devices with a Unique User ID and Hardened Password or stronger authentication method such as a physical token or biometrics.

(c) Manually lock devices whenever they are left unattended and set devices to lock automatically after a period of inactivity, if this feature is available. Maximum period of inactivity is 20 minutes.

Physically Secure the portable device(s) and/or media by

(d) Keeping them in locked storage when not in use

(e) Using check-in/check-out procedures when they are shared, and



(f) Taking frequent inventories

(2) When being transported outside of a Secured Area, portable devices and media with DSHS Confidential Information must be under the physical control of Contractor staff with authorization to access the Data.

(3) Portable devices include, but are not limited to; smart phones, tablets, flash memory devices (e.g. USB flash drives, personal media players), portable hard disks, and laptop/notebook/netbook computers if those computers may be transported outside of a Secured Area.

(4) Portable media includes, but is not limited to; optical media (e.g. CDs, DVDs), magnetic media (e.g. floppy disks, tape), or flash media (e.g. CompactFlash, SD, MMC).

h. Data stored for backup purposes.

(1) DSHS data may be stored on portable media as part of a Contractor’s existing, documented backup process for business continuity or disaster recovery purposes. Such storage is authorized until such time as that media would be reused during the course of normal backup operations. If backup media is retired while DSHS Confidential Information still exists upon it, such media will be destroyed at that time in accordance with the disposition requirements in Section 5. Data Disposition

(2) DSHS Data may be stored on non-portable media (e.g. Storage Area Network drives, virtual media, etc.) as part of a Contractor’s existing, documented backup process for business continuity or disaster recovery purposes. If so, such media will be protected as otherwise described in this exhibit. If this media is retired while DSHS Confidential Information still exists upon it, the data will be destroyed at that time in accordance with the disposition requirements in Section 5. Data Disposition.

4. Data Segregation.

a. DSHS Data must be segregated or otherwise distinguishable from non-DSHS data. This is to ensure that when no longer needed by the Contractor, all DSHS Data can be identified for return or destruction. It also aids in determining whether DSHS Data has or may have been compromised in the event of a security breach. As such, one or more of the following methods will be used for data segregation.

b. DSHS Data will be kept on media (e.g. hard disk, optical disc, tape, etc.) which will contain no non-DSHS data. And/or,

c. DSHS Data will be stored in a logical container on electronic media, such as a partition or folder dedicated to DSHS Data. And/or,

d. DSHS Data will be stored in a database which will contain no non-DSHS data. And/or,

e. DSHS Data will be stored within a database and will be distinguishable from non-DSHS data by the value of a specific field or fields within database records.

f. When stored as physical paper documents, DSHS Data will be physically segregated from non-DSHS data in a drawer, folder, or other container.



g. When it is not feasible or practical to segregate DSHS Data from non-DSHS data, then both the DSHS Data and the non-DSHS data with which it is commingled must be protected as described in this exhibit.

5. Data Disposition. When the contracted work has been completed or when no longer needed, except as noted in Section 3. Protection of Data b. Network Server Disks above, Data shall be returned to DSHS or destroyed. Media on which Data may be stored and associated acceptable methods of destruction are as follows:

Data stored on: Will be destroyed by:Server or workstation hard disks, or

Removable media (e.g. floppies, USB flash drives, portable hard disks) excluding optical discs

Using a “wipe” utility which will overwrite the Data at least three (3) times using either random or single character data, or

Degaussing sufficiently to ensure that the Data cannot be reconstructed, or

Physically destroying the disk

Paper documents with sensitive or Confidential Information

Recycling through a contracted firm provided the contract with the recycler assures that the confidentiality of Data will be protected.

Paper documents containing Confidential Information requiring special handling (e.g. protected health information)

On-site shredding, pulping, or incineration

Optical discs (e.g. CDs or DVDs) Incineration, shredding, or completely defacing the readable surface with a coarse abrasive

Magnetic tape Degaussing, incinerating or crosscut shredding

6. Notification of Compromise or Potential Compromise. The compromise or potential compromise of DSHS shared Data must be reported to the DSHS Contact designated in the Contract within one (1) business day of discovery. If no DSHS Contact is designated in the Contract, then the notification must be reported to the DSHS Privacy Officer at [email protected]. Contractor must also take actions to mitigate the risk of loss and comply with any notification or other requirements imposed by law or DSHS.

7. Data shared with Subcontractors. If DSHS Data provided under this Contract is to be shared with a subcontractor, the Contract with the subcontractor must include all of the data security provisions within this Contract and within any amendments, attachments, or exhibits within this Contract. If the Contractor cannot protect the Data as articulated within this Contract, then the contract with the sub-Contractor must be submitted to the DSHS Contact specified for this contract for review and approval.


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